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Cardiology Final Exam > Module 8: Congenital & Acquired Heart Disease - Rhinehart & Schober (Weeks 12 & 13) > Flashcards

Module 8: Congenital & Acquired Heart Disease - Rhinehart & Schober (Weeks 12 & 13) Flashcards

1
Q

C35: Valvular heart disease - Mitral and tricuspid valves

A

C35: Valvular heart disease - Mitral and tricuspid valves

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2
Q

Valvular Anatomy:
- 2 large papillary muscles
- Anterior leaflet
- Posterior leaflet
- Chordae tendinae

A

Mitral Valve

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3
Q

Valvular Anatomy:
- Many small papillary muscles
- Two functional leaflets (“tricuspid”)
- septal leaflet
- parietal leaflet (fused anterior and posterior)

A

Tricuspid Valve

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4
Q

List some things that would make them leak:

A
  • Congenital disease (dysplasia)
  • Acquired disease (way more common)
    - Degeneration
    - Endocarditis
    - Functional mitral regurgitation (from ventricular dilation)
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5
Q

Congenital valve dysplasia (Atrioventricular Valve Dysplasia):
- Eccentric hypertrophy (volume overload)
- Atrial and ventricular enlargement
- Systolic murmur

A

Regurgitation

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6
Q

Congenital valve dysplasia (Atrioventricular Valve Dysplasia):
- Obstruction of ventricular filling
- Severe atrial enlargement

A

Stenosis

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7
Q

Congenital valve dysplasia (Atrioventricular Valve Dysplasia):
- Dynamic LV outflow tract obstruction & mitral regurgitation

A

Systolic anterior motion (mitral)

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8
Q

What valve dysplasia is most commonly seen in cats, German shepherd dogs, golden retrievers & bull terriers?

A

Mitral Valve Dysplasia

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9
Q

Mitral Valve Dysplasia:
- Dynamic LV outflow tract obstruction
- Mitral regurgitation
- Concentric LV hypertrophy

A

Systolic anterior motion (SAM)
- Treat with atenolol
- Dogs grow and can grow out of it (good)

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10
Q

Triscupid Valve Dysplasia can result in …

A

Severe RA & RV enlargement

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11
Q

What valve dysplasia is most seen in labrador retrievers?

A

Tricuspid valve dysplasia

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12
Q

Acquired Atrioventricular Valve disease:
- Valvular thickening, prolapse, and regurgitation
- Mitral > Tricuspid (pressures are higher on the left side)
- Most common acquired heart disease (dogs, horses)
- 75% of all heart disease in dogs
- 90% of all small breed dogs > 8 years

A

Degenerative Valve Disease (DVD)

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13
Q

Degenerative Valve Disease (DVD): Equine Heart Disease
Valvular degeneration is common in …

A

Aging horses

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14
Q

Degenerative Valve Disease (DVD): Equine Heart Disease
(T/F) Valvular degeneration is a common cause of morbidity and mortality in horses

A

False

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15
Q

Degenerative Valve Disease (DVD): Equine Heart Disease
What is the most likely cause of CHF?

A

Mitral Valve Degeneration

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16
Q
  • A slowly progressive disease
  • Time from a murmur to death/CHF :
    • 4-5 years
    • Shorter for Cavalier King Charles Spaniel
A

Degenerative Mitral Valve Disease

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17
Q

Degenerative Mitral Valve Disease:

List the things that can accelerate disease progression:

A
  • Elevated blood pressure (high systemic blood pressure)
  • Breed predilections
  • Ruptured chordae tendineae
    -Arrhythmias
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18
Q

EPIC (Evaluation of Pimobendan in Cardiomegaly) Study:

A
  • Multicenter, double-blinded, placebo-controlled study
  • At least moderate LA LV enlargement
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19
Q

How many more months did pimobendan “give”?

A

15 more months

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20
Q

EPIC Study:
How was heart enlargement determined?

A
  • Echocardiography
    • Left atrial enlargement (LA:Ao > 1.6)
    • Left ventricular enlargement (LV internal diastolic dimension, normalized to body weight > 1.7)
  • Radiography: VHS of at least 10.5* (you need both radiograph and echo)
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21
Q

What is the cut-off if they cannot have an echo done?

A

VHS > 11.5

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22
Q

What do you do if the VHS is measuring between 10.6 - 11.4?

A
  • Recheck chest radiographs in 6 months
  • If VHS increase by > 0.5 vertebra in 6 months give pimobendan
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23
Q

Stage C = _________

A

CHF (Left-sided congestive heart failure)

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24
Q

IN - Hospital treatment:
What does F-O-N-S-P mean?

A
  • Furosemide
  • Oxygen
  • Nitroglycerine ointment
  • Sedation
  • Pimobendan
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25
Q

Chronic therapy:
What does “Pets Are Special For Everyone” mean?

A
  • Pimobendan
  • ACE-I
  • Spironolactone
  • Furosemide
  • Exercise retriction
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26
Q

Degenerative Mitral Valve Disease Prognosis:
What is the median survival time after the onset of CHF?

A

1 year

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27
Q

List the Natural Outcomes for Degenerative Mitral Valve Disease:

A
  • No clinical signs (common)
  • Congestive heart failure (CHF) (relatively common)
    • Left heart enlargement
    • Pulmonary venous congestion
    • Pulmonary Edema
  • Bronchial compression (common)
  • Pulmonary hypertension
  • Supraventricular arrhythmias
    • atrial fibrillation
  • Left atrial tear
    • pericardial effusion
    • acquired atrial septal defect
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28
Q

What would be the treatment for Pulmonary Hypertension (secondary to left-heart disease)?

A

Diuretics (reduce LA pressure)

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29
Q

An apparently healthy 10-year-old mixed breed dog (8 kg) presents for annual vaccines and examination. The owner reports no abnormal history or clinical signs. Upon physical exam, you hear a new grade 3/6 left apical systolic murmur. What is the most likely cause of the murmur in this dog?

A

Degenerative mitral valve disease

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30
Q

Why is a mitral valve regurgitation murmur typically heard more readily as compared to a murmur or similar regurgitant volume as tricuspid valve regurgitation?

A

The pressure difference in systole between the LA and LV is greater than between he RA and RV

31
Q

A 10-year-old male-castrated miniature Dachshund with known ACVIM Stage B2 degenerative mitral valve disease presents for polyuria and polydipsia and excessive panting. Based on the physical exam (alopecia, distended abdomen) and blood work findings, you suspect Cushing’s disease (hyperadrenocorticism). You check systemic blood pressure and get a systolic reading of 190 mmHg. Which statement below about managing this case is most CORRECT?

A. The blood pressure is normal for a dog in the hospital; therefore, no treatment is needed.

B. Ideally the blood pressure should be high to reduce the amount of mitral regurgitation.

C. Treatment for systemic hypertension is warranted given high blood pressure can worsen mitral regurgitation.

D. ACVIM Stage B2 degenerative mitral valve disease indicates there is no mitral regurgitation, only a predisposition for developing the disease.

E. High left atrial pressure from heart disease is likely the cause of the elevated blood pressure reading.

A

C. Treatment for systemic hypertension is warranted given high blood pressure can worsen mitral regurgitation.

32
Q

C36: Valvular heart disease - Semilunar valves

A

C36: Valvular heart disease - Semilunar valves

33
Q

Diseases of the Semilunar Valves:
- Congenital aortic | valve acquired subaortic stenosis
- Degeneration of the AoV (horse)
- Bacterial endocarditis
- Aortic regurgitation with congenital heart dz (SAS, VSD) or idiopathic Ao dilation

A

Aortic Valvular (AoV) Disease

34
Q

Diseases of the Semilunar Valves:
- Congenital stenosis - PS
- valvular | subvalvular | supravalvular
- Pulmonary regurgitation in severe plum hypertension

A

Pulmonary Valvular Disease

35
Q
  • Common congenital heart disease of dogs
  • Rare in other veterinary species
  • Typically valvular obstruction (Fusion, thickening, or hypoplasia)
    - “valve doming”
  • Subvalvular obstruction can occur 2nd to RV hypertrophy
  • Often patent foramen ovale
  • Often coronary malformations (bulldog, boxer)
A

Pulmonary Stenosis (PS)

36
Q

Auscultation for a Pulmonary Stenosis:
(T/F) Ejection murmur loudest on the RIGHT heart base

A

False, it is on the left!

37
Q

C37: Valvular Heart disease, Infective endocarditis

A

C37: Valvular Heart disease, Infective endocarditis

38
Q

What is a rare disease, but is most common in young, large-breed, and in cattle & horses?

A

Bacterial (infectious) endocarditis

39
Q

(T/F) IE is always a systemic disease

A

True

40
Q

List the classic findings for IE or BE:

A
  • Fever of unknown origin
  • Shifting lameness
  • Intermittent joint swelling
  • Left shift
41
Q

What often leads to temporary improvement of signs thus masking the underlying disease process?

A

Pre-treatment w/ antibiotics and corticosteroids

42
Q

What heart valve is most likely affected in dogs and cats?

A

Left-sided heart valves

43
Q

What heart valves are most often affected in horses, swine, and cattle?

A

Right-sided heart valves

44
Q

(T/F) The peripheral purulent source of BE can often be identifies

A

False, can often NOT be identified

45
Q

What will often lead to diagnosis in most cases, with history, clinical, and blood biochemical findings?

A

Echocardiography
- has a reasonable sensitivity & specificity for IE
- It CANNOT be used as a stand-alone test in the diagnosis of IE

46
Q

In what percent of cases with BE is blood and urine cultures negative?

A

> 50% of cases

47
Q

(T/F) Prognosis of BE is very poor despite long and expensive therapy

A

True

48
Q

Which statement about infective endocarditis (IE) is CORRECT?
a. IE is a common condition in small dogs but not cats.
b. Pulmonary stenosis and VSDs predispose to the development of IE in animals.
c. The portal of entry of bacteria is almost always a deep skin wound.
d. Bartonella IE is an emerging condition in dogs and cats and most commonly affects the aortic valve.
e. Valve vegetations are composed of thrombin, antibody-antigen complexes, granulomatous tissue, and degenerate neutrophils

A

d. Bartonella IE is an emerging condition in dogs and cats and most commonly affects the aortic valve.

49
Q

(T/F) Valve vegetations preferentially develop at the downstream side of the valve (eg., the LV side of the mitral valve and the ascending aorta side of the aortic valve)

A

False

50
Q

All of the following are common consequences of IE of the aortic valve, EXCEPT?
a. Systemic thromboemboli
b. Fever
c. Systemic hypertension
d. Aortic regurgitation
e. Bacteremia
f. A to-and-fro heart murmur from aortic stenosis and aortic regurgitation.

A

c. Systemic hypertension

51
Q

All of the following are ‘classical’ (common) diagnostic findings of IE in dogs, EXCEPT?
a. A new heart murmur.
b. Fever of unknown origin.
c. Leukocytosis with left shift and thrombocytopenia.
d. Septic (purulent) polyarthritis.
e. Presence (current or previous) of systemic disease.
f. Shifting lameness and signs of vasculitis (eg., petechiae)

A

d. Septic (purulent) polyarthritis.

52
Q

Which statement about the diagnosis and treatment of IE is CORRECT?
a. Echocardiography is the clinical gold standard in the diagnosis of IE but cannot be used as a stand-alone test.
b. Blood cultures should always be done to confirm IE. A negative culture definitely rules out the presence of IE.
c. Fever, laboratory signs of degeneration, and a heart murmur > 3/6 best heard right apically strongly support the diagnosis of IE.
d. Intravenous antibiotics for the first 8 weeks of therapy, followed by another 6-week period of oral antibiotics, are the standard of care in the treatment of IE.
e. Blood cultures should always be analyzed if IE is suspected. For culture results to be MOST accurate, 6 blood samples taken within 3 hours including 1 from the left ventricular lumen (direct puncture) should be analyzed.

A

a. Echocardiography is the clinical gold standard in the diagnosis of IE but cannot be used as a stand-alone test.

53
Q

C38: Shunts

A

C38: Shunts

54
Q

When are Intra and extracardiac shunts frequently seen in small animals?

A

They are frequently seen in small animals with PDA, most common in dogs and VSD most common in cats

55
Q

List the characteristic clinical findings of a PDA;

A
  • Continuous heart murmur (systolic-diastolic) at the LEFT heart BASE
  • Hyperdynamic ARTERIAL PULSE (pulsus magnus)
56
Q

List the characteristic clinical finding of a VSD:

A
  • Loud
  • Holosystolic heart murmur on the RIGHT side of the thorax
57
Q

(T/F) Both PDA and VSD can finally lead to left-sided CHF, depending on size

A

True

58
Q

How can PDA be cured?

A

Interventional (catheter-based0 closure of open chest surgery

59
Q

(T/F) All VSDs (small or large) are treated medically

A

False, Small VSDs are NOT TREATED while larger VSDs are treated medically

60
Q

What can PDA and VSD lead to?

A
  • Pulmonary Hypertension
  • Finally Shunt reversal (Eisenmenger’s physiology)
61
Q

With PDA ________ would be observed

A

Differential cyanosis

62
Q

With VSD would lead to _____________

A

Central Cyanosis

63
Q

Term:
Belongs to the spectrum of cyanotic congenital heart diseases and leads to polycythemia, hyperviscosity, cyanotic spells, and sudden death

A

Tetralogy of Fallot

64
Q

Which characteristic of a PDA is NOT correct?
a. It is a congenital malformation most often associated with a continuous heart murmur
b. The femoral arterial pulse is very strong.
c. Pulmonary over circulation and a ductal bump (PA bulge) will be seen on thoracic radiographs
d. Blood flow is from the ascending aorta into the main pulmonary artery
e. Shunt direction is usually left-to-right leading to LA and LV enlargement

A

d. Blood flow is from the ascending aorta into the main pulmonary artery

65
Q

What match about congenital heart disease and diagnostic findings is CORRECT?
a. Large VSD – left parasternal systolic heart murmur
b. Tetralogy of Fallot – left axis shift with tall R-wave on the ECG
c. PDA – early signs of right-sided CHF if not closed
d. Patent foramen ovale (PFO) – right parasternal systolic heart murmur
e. Large ASD– left basilar systolic heart murmur from ‘relative’ pulmonary stenosis

A

e. Large ASD– left basilar systolic heart murmur from ‘relative’ pulmonary stenosis

66
Q

In a 4-months old dog with a large PDA, all cardiac
chambers are expected to be enlarged, EXCEPT:
a. Right ventricle
b. Left atrium
c. Aortic root
d. Left ventricle
e. Pulmonary artery

A

a. Right ventricle

67
Q

Which statement about Eisenmenger’s complex
(EC) is CORRECT?
a. EC is the consequence of a PDA leading to cyanosis of the oral-facial mucus membranes with pink caudal (vagina, prepuce) mucus membranes (= ‘differential’ cyanosis)
b. The cause of EC is severe systemic hypertension leading to shunt reversal
c. EC needs to be treated early with CHF medications (pimobendan, furosemide, enalapril, and spironolactone)
d. EC leads to PDA or VSD flow reversal due to chronic pulmonary overflow-induced supra-systemic (severe) pulmonary hypertension
e. EC is the common consequence of a small (restrictive) left-to-right shunting VSD

A

d. EC leads to PDA or VSD flow reversal due to chronic pulmonary overflow-induced supra-systemic (severe) pulmonary hypertension

68
Q

“Horst” is a 3-year old Maltese dog with a history of syncope associated with cyanotic mucus membranes after short periods of exercise. The dog has had a 2 3/6 left basilar systolic heart murmur since birth. On ECG, there is normal sinus arrhythmia with right-axis shift and a prominent S-wave in leads I, II, and aVF. On chest films, lung vessels are small and the right ventricle appears enlarged whereas the left ventricle seems small. What is the most likely diagnosis?
a. VSD
b. PDA
c. ASD
d. Subaortic stenosis
e. Tetralogy of Fallot

A

e. Tetralogy of Fallot

69
Q

“Mickey” is a 1-year old Persian cat with a recent onset of open-mouth breathing occurring several times a day. The owner also noticed some intermittent purple discoloration of the cats’
tongue. A heartworm test came back negative. On auscultation, there is a 2-3/6 right parasternal systolic heart murmur and increased respiratory sounds. On ECG there is sinus tachycardia with prominent R-waves (R=1.3 mV, N: <0.9). Chest films indicate cardiomegaly (left atrium and left ventricle) and increased & tortuous pulmonary arterial vessels with mild interstitial opacities. Which is the most likely diagnosis in Mickey?
a. Nonrestrictive VSD with pulmonary hypertension
b. Tetralogy of Fallot
c. Severe pulmonary valve stenosis
d. HCM with left-to-right shunting
e. Large ASD with pulmonary over-circulation

A

a. Nonrestrictive VSD with pulmonary hypertension
- pulmonary Overcirculation
- Increased venous return
- LA dilation
- LV dilation
- L-R shunt loud systolic murmur on the right
- Tongue blue, deoxygenated

70
Q

C39: Pericardial disease and cardiac tumors

A

C39: Pericardial disease and cardiac tumors

71
Q

What is the treatment of choice for a cat with congestive heart failure and a mild amount of pericardial effusion?
a) pericardiocentesis
b) steroids
c) lasix, oxygen, and sedation
d) antibiotics and intravenous fluid bolus
e) clot stabilizing drugs

A

c) lasix, oxygen, and sedation

72
Q

What is the most common cause of hemorrhagic pericardial effusion in an older dog?
a) left atrial tear
b) coagulopathy
c) cardiac neoplasia
d) septic pericarditis
e) trauma

A

c) cardiac neoplasia

73
Q

What is the most important treatment for an animal with cardiac tamponade secondary to pericardial effusion?
a) pericardiocentesis
b) steroids
c) lasix
d) Intravenous fluid bolus
e) clot stabilizing drugs

A

a) pericardiocentesis

74
Q

(T/F) Peritoneopericardial diaphragmatic
hernia (PPDH) is often in incidental finding

A

True

Cardiology Final Exam (5 decks)

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